Ganglionic cysts are fluid filled cysts that are common on the lateral aspect of the ankle and on the top of the foot. Clinicians and surgeons believe that ganglionic cysts are derived from weakened areas of tendon sheath. The weakening in the tendon sheath allows for herniation of the fluid within the tendon out into the defect. This herniation is much like what happens when you squeeze a water balloon. The result is a bubble of fluid enclosed in a defective portion of the balloon (tendon sheath). This bubble of fluid is what we call a ganglionic cyst.

Ganglionic cysts are also known as Bible cysts or Gideon's cysts. These names are derived from the historical practice of treating the cyst by rupturing it with a heavy book. Ganglionic cysts are also sometimes called synovial cysts. Ganglionic cysts and synovial cysts are very similar in there presentation and appearance, but differ in their origin. Ganglionic cysts are derived from tendon sheath while synovial cysts are derived from the lining of a joint (synovium).

Treatment of Ganglionic Cysts

If asymptomatic, many patients choose to ignore a ganglionic cyst. If the ganglionic cyst becomes painful, treatment options include aspiration of  the cyst or surgical excision. Aspiration of a ganglionic cyst is a common office procedure.  Following aspiration, a steroid injection is often used to fill the cyst. Steroid is used in an attempt to scar the pedicle of the cyst to destroy the communication between the ganglionic cyst and the tendon. Aspiration of ganglionic cysts with instillation of steroid is a common practice but only successful in about 50% of cases.

Surgical excision of a ganglionic cyst has a higher success rate (85-90%) compared to aspiration of the cyst.  But surgical excision of a ganglionic cyst does carry with it the cost and potential complications associated with any surgery. The following steps show the excision of a ganglionic cyst on the lateral aspect of the foot. This ganglionic cyst was excised due to the patient's inability to fit into an enclosed shoe. Depending upon the size and location of the ganglionic cyst, most patients can bear weight on the foot immediately following surgery. Excision of a ganglionic cyst can be completed in approximately 45 minutes and is performed with either a general anesthetic or local anesthetic with sedation. Recovery time and return to activities depends upon the success of the surgery and the extent of the dissection needed to excise the cyst.

Synovium - Every joint is surrounded by a structure called the joint capsule.  The inner lining of the capsule is a tissue called synovium.  Synovium produces joint fluid that lubricates the joint.

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No additional information is available for this topic.

Many ganglionic cysts are asymptomatic.  In cases where ganglionic cysts do cause pain, we usually find a nerve directly affected by the pressure of the cyst pushing against the nerve.  In some cases, pain may be due to the inability to fit the cyst into an enclosed shoe.

Ganglionic cysts can vary in their onset and size.  Many ganglionic cysts will change in size based upon the volume of fluid within the cyst and the transfer of that fluid between the cyst and tendon sheath.

The differential diagnoses for this condition includes:

Hematoma

Benign soft tissue or bone tumor

Malignant soft tissue or bone tumor

Neurofibroma

• Tumors Of The Foot

• Peroneal Tendonitis

• Sinus Tarsi Syndrome

• Foot and Ankle Surgery

• Foot and Ankle Anatomy

This article was written by Jeffrey A. Oster, DPM and was last edited on 1-28-10.